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| {{DX tag | Pneumonia-VAP (vent acq'd)| PNEUMONIA-VAP (ventilator acq'd) | 39-00 | '''Critical Care and Medicine''' | Currently Collected}} | | {{PreICD10 dx | NewDxArticle = Pneumonia, ventilator-associated (VAP)}} |
| | {{DX tag | Infection | Medical Problem| [[:Category: Pneumonia | Pneumonia ]]| PNEUMONIA-VAP (ventilator acq'd) | 3900-Ventilator Associated Pneumonia | No | 0 |'''Critical Care and Medicine''' | Currently Collected | July 1, 2006 | |}} |
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| == When to code VAP ==
| | See criteria in [[Pneumonia, ventilator-associated (VAP)]]. |
| '''Ventilator Associated Pneumonia (VAP) Criteria''' (based on NNIS definition):
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| '''If''' a patient has been on a device to assist respiration (ventilator) continuously through a tracheostomy or ETT with the '''48 hour''' period '''before onset of infection'''
| | == See Also == |
| | * [[QA Infection]] for info common to the [[QA Infection CLI]] and the [[QA Infection VAP]] project |
| | * alternate diagnoses [[:Category:Pneumonia]] |
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| '''and''' if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia
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| '''and''' if '''at least '''one'''''' of the following criteria is met:
| | [[Category:Pneumonia (old)]] |
| * Fever (T > 38) with no other cause
| | [[Category:QAInfection]] |
| * Leukopenia WBC(<4X10(9)). or leukocytosis (>12x 10(9).
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| * Altered mental status with no other causes in >69 year old.
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| '''and''' if '''at least '''one'''''' of the following criteria is met:
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| * New onset of purulent secretions
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| * Change in character of sputum
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| * Increased volume of purulent secretions
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| * Increased suction requirement
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| * New onset of worsening cough
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| * New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
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| * Increased oxygen or ventilation requirement
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| '''and''' if '''at least '''one'''''' of the following criteria is met:
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| * Pathogen isolated from sputum in the last 48 hours
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| * Positive blood cultures not related to another infection
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| * Positive pleural fluid culture.
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| [[Category:Data Collection Guide]] | |
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| == When not to code VAP ==
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| *Do not code a VAP if the criteria are not met as described in "When to code a VAP"--[[User:LKolesar|LKolesar]] 09:00, 17 June 2008 (CDT)
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| == Clarification of coding VAP when moving patients between units in the city ==
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| When coding VAP's they are coded as "complication" when they occur at a specific center. However, when these patients are transferred to other centers and the VAP is still being treated, then the VAP should be coded as part of the admitting diagnosis.
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| When Julie looks at VAP rates in ICU's she only looks for the VAP code in the complication slots. The site where the patient had the VAP occur in complication codes is the site that is given the credit. A unit where a patient has a VAP in the admitting diagnosis is not included in stats for VAP rates.
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| When a VAP appears in the admission code slots, Julie tracks back to where patient came from and makes sure that the ICU prior to the transfer, coded the VAP in their complications, if not, you will get a query to audit the diagnosis.
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| {{Discussion}}
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| == Discussion ==
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| * If a patient has a VAP in the ICU and is then transferred to the ward, should the ward code the vap in the admit diagnosis also? I had been talking to the medicine data collectors about this issue and they said they were told not to code it as a HAP but as a HAP.
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| **When a VAP that had been acquired in ICU is not resolved when a patient is transferred to a Medicine ward, and it is still being treated on the Medicine ward then VAP '''should be''' an '''admitting diagnosis''' code. If VAP was resolved in the ICU before the patient was sent to the ward, then don't include in your diagnosis codes.
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| **When the Statistician links admissions in the database between ICU'a & medicine wards in the city, those patient that have VAP in admitting diagnosis are excluded from complication statistics. The patient encounter that had the VAP coded in the '''acquired diagnosis''' slot is the unit that is given credit for the '''complication''' occuring in that unit. [[User:TOstryzniuk|TOstryzniuk]] 14:10, 16 June 2008 (CDT)
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| * Should ETT acronym be explained? [[User:Ttenbergen|Ttenbergen]] 11:07, 17 June 2008 (CDT)
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| * Tried to find out whether leuco or leuko is more likely spelling for consistency, and it appears to be "leuko" so changed "leuco" above. Please change back if problem. [[User:Ttenbergen|Ttenbergen]] 11:10, 17 June 2008 (CDT)
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| * I think all the "if one of" above should be changed to "if ''at least'' one of". Done. If this is not true, please change back, but also let me know for future reference. [[User:Ttenbergen|Ttenbergen]] 11:11, 17 June 2008 (CDT)
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| [[Category:Diagnosis Coding]] | |